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  • LOSS, GRIEF, AND LOSS, GRIEF, AND BEREAVEMENT SUPPORTBEREAVEMENT SUPPORT

    FRED NELSONPSYCHOSOCIAL PROGRAM SPECIALISTPALLIATIVE CARE PROGRAMWINNIPEG REGIONAL HEALTH AUTHORITY(204) 8370753fnelson@ggh.mb.ca

  • WHAT LIES BEHIND USAND WHAT LIES BEFORE USARE TINY MATTERSCOMPARED TOWHAT LIES WITHIN US

    OLIVER WENDELL HOLMES

  • Tasks of MourningTasks of Mourning

    Acceptance of the reality of lossAcceptance of the reality of lossExperience the pain of griefExperience the pain of griefAdjustment to the environment Adjustment to the environment without the deceasedwithout the deceasedWithdrawal of emotional energy and Withdrawal of emotional energy and reinvesting in other relationships reinvesting in other relationships

    Worden, (1982)Worden, (1982)

  • Experiential ModelExperiential Model

    Getting the newsGetting the newsFinding outFinding outFacing realitiesFacing realitiesBecoming engulfed with sufferingBecoming engulfed with sufferingEmerging from the sufferingEmerging from the sufferingGetting on with lifeGetting on with lifeExperiencing personal growthExperiencing personal growth

    Hogan, (1996)Hogan, (1996)

  • Transitions in Dying and Transitions in Dying and BereavementBereavement

    Walking the edges: when a death Walking the edges: when a death occursoccursEntering the depths: adjusting to Entering the depths: adjusting to losslossReconnecting with the world: Reconnecting with the world: mending the heartmending the heart

    Cairns etal. (2003)Cairns etal. (2003)

  • WALKING THE EDGESWALKING THE EDGES

    SOCIALSOCIAL

    AutopilotAutopilotWithdrawal or fear of Withdrawal or fear of being alonebeing aloneUnrealistic Unrealistic expectationsexpectationsPoor judgmentPoor judgment

    PHYSICALPHYSICAL

    Shortness of breath, Shortness of breath, palpitationspalpitationsDigestive upsetsDigestive upsetsShockShockLow energy, Low energy, weakness, weakness, restlessnessrestlessness

  • WALKING THE EDGESWALKING THE EDGES

    EMOTIONALEMOTIONAL

    Crying, sobbing, Crying, sobbing, wailingwailingIndifference, Indifference, emptinessemptinessHelplessness, Helplessness, outrageoutrage

    COGNITIVECOGNITIVE

    Confusion, Confusion, forgetfulness, poor forgetfulness, poor concentrationconcentrationDaydreaming, denialDaydreaming, denialConstant thoughts Constant thoughts about person who about person who died or death itselfdied or death itself

  • WALKING THE EDGESWALKING THE EDGES

    SPIRITUALSPIRITUAL

    Blaming God or Blaming God or lifelife

    Lack of meaning, direction, or hopeLack of meaning, direction, or hope

    Wishing to join the person who diedWishing to join the person who died

  • Adjusting to lossAdjusting to lossSocialSocialContinued withdrawal Continued withdrawal and isolation;and isolation;

    Wanting company but Wanting company but unable to ask;unable to ask;

    Rushing into new Rushing into new relationships;relationships;

    SelfSelf--consciousnessconsciousness

    PhysicalPhysicalTight chest, sharp Tight chest, sharp pangs, shortness of pangs, shortness of breath;breath;

    Digestive upsets;Digestive upsets;Aimless activity, Aimless activity, gnawing emptiness;gnawing emptiness;

    Changes in appetite or Changes in appetite or sleep patternssleep patterns

  • Adjusting to lossAdjusting to lossEmotionalEmotional

    intense and conflictingintense and conflictingemotions;emotions;Anger, sadness, guilt, Anger, sadness, guilt, hopelessness;hopelessness;Generalized anxiety;Generalized anxiety;Magnified fears for Magnified fears for self, othersself, others

    CognitiveCognitiveSense of going crazy;Sense of going crazy;Memory problems;Memory problems;Understanding and Understanding and concentration poor;concentration poor;Vivid dreams and Vivid dreams and nightmaresnightmares

  • Adjusting to lossAdjusting to loss

    SpiritualSpiritualSensing the presence of the person who Sensing the presence of the person who died; visitations;died; visitations;

    Continued lack of meaning or purpose;Continued lack of meaning or purpose;

    Attempts to contact the person who diedAttempts to contact the person who died

  • MENDING THE HEARTMENDING THE HEART

    SOCIALSOCIAL

    More interest in daily More interest in daily affairs of othersaffairs of othersAbility to reach out and Ability to reach out and meet othersmeet othersEnergy for social Energy for social relationshipsrelationshipsDesire for independence Desire for independence resurfacesresurfaces

    PHYSICALPHYSICAL

    Symptoms subsideSymptoms subside

    Sleep pattern and Sleep pattern and appetite return to normalappetite return to normalGutGut--wrenching emptiness wrenching emptiness lightenslightens

  • MENDING THE HEARTMENDING THE HEART

    EMOTIONALEMOTIONAL

    Emotions less intenseEmotions less intenseFeeling of coming out Feeling of coming out of a fogof a fogMore peace and More peace and happinesshappinessSome guilt about how Some guilt about how life goes onlife goes on

    COGNITIVECOGNITIVE

    Perspective about Perspective about death increasesdeath increasesRemember with less Remember with less painpainMemory, Memory, concentration improveconcentration improveDreams/nightmares Dreams/nightmares decreasedecrease

  • MENDING THE HEARTMENDING THE HEART

    SPIRITUALSPIRITUAL

    Connection with religious and/or spiritual Connection with religious and/or spiritual beliefsbeliefsLife has new meaning/purposeLife has new meaning/purposeAcceptance that death is part of lifeAcceptance that death is part of life

  • DISENFRANCHISED GRIEFDISENFRANCHISED GRIEF

    GRIEF THAT PERSONS EXPERIENCE GRIEF THAT PERSONS EXPERIENCE WHEN THEY INCUR A LOSS THAT IS WHEN THEY INCUR A LOSS THAT IS NOT OR CANNOT BE OPENLY NOT OR CANNOT BE OPENLY ACKNOWLEDGED, PUBLICLY ACKNOWLEDGED, PUBLICLY MOURNED, OR SOCIALLY SUPPORTEDMOURNED, OR SOCIALLY SUPPORTED

  • DISENFRANCHISED GRIEFDISENFRANCHISED GRIEF

    RELATIONSHIP NOT RECOGNIZEDRELATIONSHIP NOT RECOGNIZED

    LOSS NOT RECOGNIZEDLOSS NOT RECOGNIZED

    GRIEVER NOT RECOGNIZEDGRIEVER NOT RECOGNIZED

  • DISENFRANCHISED GRIEF : DISENFRANCHISED GRIEF : IMPACTIMPACT

    GRIEF INTENSIFIEDGRIEF INTENSIFIED

    AMBIVALENT AMBIVALENT RELATIONSHIP/CONCURRENT RELATIONSHIP/CONCURRENT CRISIS=COMPLICATED GRIEFCRISIS=COMPLICATED GRIEF

    LACKING NORMAL SUPPORTLACKING NORMAL SUPPORT

  • COMPLICATED GRIEFCOMPLICATED GRIEF

    Preoccupation with yearning for, and searching Preoccupation with yearning for, and searching for the deceasedfor the deceasedIntrusive images, ideas, recurrent Intrusive images, ideas, recurrent dreams/nightmaresdreams/nightmaresActive avoidance of thoughts, communication, or Active avoidance of thoughts, communication, or action associated with the lossaction associated with the lossInterference with daily functioningInterference with daily functioningPersistent symptoms Persistent symptoms

    Ogrodniczuk (2003)Ogrodniczuk (2003)

  • Risk FactorsRisk Factors

    History of difficult relationshipHistory of difficult relationshipChallenging circumstances of the deathChallenging circumstances of the deathIntensity of grief reactions, both in Intensity of grief reactions, both in anticipatory grief and bereavementanticipatory grief and bereavementPoor quality of support network as Poor quality of support network as perceived by bereaved personperceived by bereaved personHistory of unresolved losses (e.g. grief, History of unresolved losses (e.g. grief, abuse, abandonment)abuse, abandonment)

  • Risk Factors (contRisk Factors (contd)d)

    Concurrent stresses (e.g. job or Concurrent stresses (e.g. job or relationship difficulties, other caregiving relationship difficulties, other caregiving roles, financial distress)roles, financial distress)Multiple lossesMultiple lossesHistory of drug or alcohol useHistory of drug or alcohol useHistory of illness, mental health issues, History of illness, mental health issues, developmental problemsdevelopmental problems

    Cairns, Johnson,& Wainwright, (1993)

  • Grief and DepressionGrief and DepressionRange & variability of Range & variability of moods and feelingsmoods and feelingsCapable of internal and Capable of internal and external expressionexternal expressionGuilt assoc. with lossGuilt assoc. with lossWants solitude but Wants solitude but responds to warmthresponds to warmthSporadic pleasure, Sporadic pleasure, retain sense of humorretain sense of humor

    Moods and feelings are Moods and feelings are low, more staticlow, more staticAbsence of externally Absence of externally directed anger, directed anger, internally directedinternally directedLoss confirms they are Loss confirms they are bad or worthlessbad or worthlessFear being alone or are Fear being alone or are unresponsive to othersunresponsive to othersNo pleasure, sense of No pleasure, sense of humorhumor

    Fleming, (1986)

  • CHILDRENCHILDRENS GRIEFS GRIEFChildren know and understand much more than Children know and understand much more than we give them credit forwe give them credit forOne of the biggest impediments to childrenOne of the biggest impediments to childrens s healing after death ishealing after death isadultsadultsGrieving children donGrieving children dont need to be fixedt need to be fixedDonDont need to be t need to be taughttaught as much as as much as allowedallowed..make their own meaning..make their own meaningChildren are resilient, but not in a vacuumChildren are resilient, but not in a vacuumlearn your theories well but lay them aside learn your theories well but lay them aside when you touch the reality of the living soulwhen you touch the reality

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